Background: The association between insurance status and outcome has not been well established for patients with Hodgkin Lymphoma (HL). The purpose of this study was to examine the disparities in overall survival (OS) by insurance status in a large cohort of patients with HL. Methods: We used a prospectively collected nationwide database-the National Cancer DataBase (NCDB) to evaluate clinical features and survival outcomes among patients diagnosed with stage I-IV HL from 1998 to 2011. The association between insurance status, co-variables, and outcome was assessed in a multivariate Cox proportional hazards model. Survival was estimated using the Kaplan-Meier method. Results: Among the 76,672 patients with HD within the NCDB, a total of 45,777 patients with stage I-IV disease were eligible for this study, with a median follow-up of 6.0 years. The median age was 39 years (range: 18-90). The insurance status was as follows: 3,247(7.1%) uninsured; 7,962 (17.4%) Medicaid; 30,334 (66.3%) private insurance; 3,746 (8.2%) managed care; 488 (1.0%) Medicare. Patients with unfavorable insurance status (uninsured or Medicaid-insured) were found to be older ( > 50), more advanced stage at diagnosis, with higher co-morbidity score, more commonly with “B” symptoms, and lower income and education quartiles (all p < 0.01). These patients were also less likely to receive radiotherapy, start chemotherapy promptly ( < 30 days from diagnosis), and less commonly treated at academic/research centers (all p < 0.01). Patients with unfavorable insurance had a 10-year OS of 37% vs. 80% for those with favorable insurance (p < 0.01). When adjusting for all co-variates, unfavorable insurance status was associated with a significantly decreased OS (HR = 3.32; 95% CI, 3.02-3.64, p < 0.01). Unfavorable insurance status steadily increased from 22.8% to 28.8% between 1998 and 2011. Conclusions: Our study reveals that HL patients with Medicaid or uninsured status have inferior outcomes than patients with more favorable insurance. To our knowledge, this study represents the largest dataset examining the role of insurance status on survival for patients with HL. Targeting this subset of patients with limited access to care may help improve outcomes.